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Find video protocols related to scientific articles indexed in Pubmed.
Hearing loss and cognitive decline in older adults: questions and answers.
Aging Clin Exp Res
PUBLISHED: 06-24-2014
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The association between hearing impairment, the diagnosis of dementia, and the role of sensory therapy has been proposed for some time, but further research is needed. Current understanding of this association requires the commitment of those experts who can integrate experience and research from several fields to be able to understand the link from hearing to dementia. A workshop whose panelists included experts from many areas, ranging from ear, nose and throat (ENT) to dementia's specialists, was promoted and organized by the Giovanni Lorenzini Medical Science Foundation (Milan, Italy; Houston, TX, USA) to increase the awareness of the relationship between hearing loss and dementia, and included questions and comments following a presentation from the clinical researcher, Frank Lin, who has been evaluating the relationship between hearing loss and cognitive decline since 2009.
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The stigma of low opioid prescription in the hospitalized multimorbid elderly in Italy.
Intern Emerg Med
PUBLISHED: 05-22-2014
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The primary aim of this study was to evaluate the prevalence of opioid prescriptions in hospitalized geriatric patients. Other aims were to evaluate factors associated with opioid prescription, and whether or not there was consistency between the presence of pain and prescription. Opioid prescriptions were gathered from the REgistro POliterapie Societa` Italiana di Medicina Interna (REPOSI) data for the years 2008, 2010 and 2012. 1,380 in-patients, 65+ years old, were enrolled in the first registry run, 1,332 in the second and 1,340 in the third. The prevalence of opioid prescription was calculated at hospital admission and discharge. In the third run of the registry, the degree of pain was assessed by means of a numerical scale. The prevalence of patients prescribed with opioids at admission was 3.8 % in the first run, 3.6 % in the second and 4.1 % in the third, whereas at discharge rates were slightly higher (5.8, 5.3, and 6.6 %). The most frequently prescribed agents were mild opioids such as codeine and tramadol. The number of total prescribed drugs was positively associated with opioid prescription in the three runs; in the third, dementia and a better functional status were inversely associated with opioid prescription. Finally, as many as 58 % of patients with significant pain at discharge were prescribed no analgesic at all. The conservative attitude of Italian physicians to prescribe opioids in elderly patients changed very little between hospital admission and discharge through a period of 5 years. Reasons for such a low opioid prescription should be sought in physicians' and patients' concerns and prejudices.
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Prescription drug use among older adults in Italy: a country-wide perspective.
J Am Med Dir Assoc
PUBLISHED: 03-24-2014
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In Italy, prescription drug costs represent approximately 17% of total public health expenditures. Older adults commonly use multiple drugs and, for this reason, this population is responsible for a large portion of drug-related costs. In 2012, public expenditure for pharmaceuticals in primary care exceeded 11 billion Euros (approximately 15.2 billion US $), and older adults aged 65 or older accounted for more than 60% of these costs. Recently, increased attention has been focused on studies aimed at monitoring drug use and evaluating the appropriateness of drug prescribing in older adults. In this article, we examined studies that assessed these issues in different settings at a national level. Specifically, results of surveys of prescription drug use in primary care (OsMED), hospital (GIFA, CRIME, and REPOSI) and long-term care (ULISSE and SHELTER) settings are reviewed. Overall, these studies showed that the quality of drug prescribing in older patients is far from optimal. This leads to an increased risk of negative health outcomes and increased health care costs. Data from these studies are valuable, not only to monitor drug use, but also to target interventions aimed at improving the quality of prescribing. Translating the findings of clinical research and monitoring programs will be challenging, but it will lead to quantifiable improvements in the quality of drug prescribing at a national level.
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Incidence and predictors of multimorbidity in the elderly: a population-based longitudinal study.
PLoS ONE
PUBLISHED: 01-01-2014
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We aimed to calculate 3-year incidence of multimorbidity, defined as the development of two or more chronic diseases in a population of older people free from multimorbidity at baseline. Secondly, we aimed to identify predictors of incident multimorbidity amongst life-style related indicators, medical conditions and biomarkers.
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Prevention of inappropriate prescribing in hospitalized older patients using a computerized prescription support system (INTERcheck(®)).
Drugs Aging
PUBLISHED: 08-15-2013
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Polypharmacy is very common among older adults and can lead to inappropriate prescribing, poor adherence to treatment, adverse drug events and the prevalence of potential drug-drug interactions (DDIs). Electronic prescription database software may help to prevent inappropriate prescribing and minimize the occurrence of adverse drug reactions. INTERcheck(®) is a Computerized Prescription Support System (CPSS) developed in order to optimize drug prescription for elderly people with multimorbidity.
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Prognostic value of estimated glomerular filtration rate in hospitalized elderly patients.
Intern Emerg Med
PUBLISHED: 07-12-2013
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A multicenter observational study, REPOSI (REgistro POliterapie Società Italiana di Medicina Interna), was conducted to assess the prognostic value of glomerular filtration rate (eGFR) on in-hospital mortality, hospital re-admission and death within 3 months, in a sample of elderly patients (n = 1,363) admitted to 66 internal medicine and geriatric wards. Based on eGFR, calculated by the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, subjects at hospital admission were classified into three groups: group 1 with normal eGFR (?60 ml/min/1.73 m(2), reference group), group 2 with moderately reduced eGFR (30-59 ml/min/1.73 m(2)) and group 3 with severely reduced eGFR (<30 ml/min/1.73 m(2)). Patients with the lowest eGFR (group 3) on admission were more likely to be older, to have a greater cognitive and functional impairment and a high rate of comorbidities. Multivariable logistic regression analysis showed that severely reduced eGFR at the time of admission was associated with in-hospital mortality (OR 3.00; 95 % CI 1.20-7.39, p = 0.0230), but not with re-hospitalization (OR 0.97; 95 % CI 0.54-1.76, p = 0.9156) or mortality at 3 months after discharge (OR 1.93; 95 % CI 0.92-4.04, p = 0.1582). On the contrary, an increased risk (OR 2.60; 95 % CI 1.13-5.98, p = 0.0813) to die within 3 months after discharge was associated with decreased eGFR measured at the time of discharge. Our study demonstrates that severely reduced eGFRs in elderly patients admitted to hospital are strong predictors of the risk of dying during hospitalization, and that this measurement at the time of discharge helps to predict early death after hospitalization.
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Antipsychotics prescription and cerebrovascular events in Italian older persons.
J Clin Psychopharmacol
PUBLISHED: 06-18-2013
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Meta-analyses have found conflicting evidence on the link between antipsychotics and cerebrovascular events (CVEs). The primary aim of this study was to evaluate the association between any antipsychotic prescription and CVEs in Italian elderly; second, to compare the effect of typical and atypical antipsychotics on CVEs; and third, to investigate the effect of antipsychotics on CVEs in the subgroup of persons coprescribed with acetylcholinesterase inhibitors (AChEIs). Administrative claims from community-dwelling people aged 65 to 94 years living in Northern Italy were analyzed using a retrospective case-control design, from 2003 to 2005. The primary outcome measure was a hospital discharge diagnosis of CVEs during 2005. Four age-, sex-, and local health unit-matched control subjects were identified for each case. Antihypertensive drugs, anticoagulants, platelet inhibitors, antidiabetic drugs, lipid-lowering drugs, and AChEI were used as covariates in conditional logistic regression models testing the odds ratio (OR) for CVEs due to antipsychotics use. Three thousand eight hundred fifty-five cases of CVEs were identified and matched with 15,420 control subjects. In multiadjusted models, the association of any antipsychotics, typical or atypical with CVEs, was not significant. When antipsychotics were categorized according to the number of boxes prescribed during the observational period, being prescribed with at least 19 boxes of typical antipsychotics was significantly associated with CVEs (OR, 2.4; 95% confidence interval, 1.08-5.5). An interaction was found between any antipsychotic and AChEI coprescription on CVEs (OR, 0.46; 95% confidence interval, 0.23-0.92). In conclusion, only typical antipsychotics were associated with an increased odd of CVEs, but the association was duration dependent. Persons prescribed simultaneously with AChEI and antipsychotics may be at a lower risk of CVEs.
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Guidelines for elderly patients with multimorbidity: how to cope with a dark night without fear.
Aging Clin Exp Res
PUBLISHED: 06-05-2013
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The epidemiological transition has produced a society with a growing number of the elderly affected by multiple chronic diseases which often requires polypharmacy. Despite being the main users of medications, the elderly are largely underrepresented in clinical trials, especially if they have multimorbidity. It follows that the results of these trials are not applicable in the real world and potentially harmful. In order to breach the wall of this complexity, several suggestions have been put forward, from new clinical trial methodology, simulation models, and the use of patient-centered as opposed to disease-centered indicators. It is likely that comparative effectiveness research will accelerate the shift toward a focus on "universal" outcomes on which all diseases exert an effect. I believe that there is no "one-size-fits-all" solution in this area, but two ideas come to my mind. Why do we not invest more in educating our future geriatricians? And why do we not invest in public awareness campaigns?
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Joint use of cardio-embolic and bleeding risk scores in elderly patients with atrial fibrillation.
Eur. J. Intern. Med.
PUBLISHED: 05-17-2013
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Scores for cardio-embolic and bleeding risk in patients with atrial fibrillation are described in the literature. However, it is not clear how they co-classify elderly patients with multimorbidity, nor whether and how they affect the physicians decision on thromboprophylaxis.
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Drug-drug interactions in a cohort of hospitalized elderly patients.
Pharmacoepidemiol Drug Saf
PUBLISHED: 04-11-2013
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The aim of this study is to assess the prevalence of patients exposed to potentially severe drug-drug interactions (DDIs) at hospital admission and discharge and the related risk of in-hospital mortality and adverse clinical events, readmission, and all-cause mortality at 3?months.
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Prophylaxis of venous thromboembolism in elderly patients with multimorbidity.
Intern Emerg Med
PUBLISHED: 01-25-2013
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Pharmacological thromboprophylaxis (TP) is known to reduce venous thromboembolism (VTE) in medical inpatients, but the criteria for risk-driven prescription, safety and impact on mortality are still debated. We analyze data on elderly patients with multimorbidities admitted in the year 2010 to the Italian internal medicine wards participating in the REPOSI registry to investigate the rate of TP during the hospital stay, and analyze the factors that are related to its prescription. Multivariate logistic regression, area under the ROC curve and CART analysis were performed to look for independent predictors of TP prescription. Association between TP and VTE, bleeding and death in hospital and during the 3-month post-discharge follow-up were explored by logistic regression and propensity score analysis. Among the 1,380 patients enrolled, 171 (15.2 %) were on TP during the hospital stay (162 on low molecular weight heparins, 9 on fondaparinux). The disability Barthel index was the main independent predictor of TP prescription. Rate of fatal and non-fatal VTE and bleeding during and after hospitalization did not differ between TP and non-TP patients. In-hospital and post-discharge mortality was significantly higher in patients on TP, that however was not an independent predictor of mortality. Among elderly medical patients there was a relatively low rate of TP, that was more frequently prescribed to patients with a higher degree of disability and who had an overall higher mortality.
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The Influence of Multimorbidity on Clinical Progression of Dementia in a Population-Based Cohort.
PLoS ONE
PUBLISHED: 01-01-2013
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Co-occurrence with other chronic diseases may influence the progression of dementia, especially in case of multiple chronic diseases. We aimed to verify whether multimorbidity influenced cognitive and daily functioning during nine years after dementia diagnosis compared with the influence in persons without dementia.
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Association between clusters of diseases and polypharmacy in hospitalized elderly patients: results from the REPOSI study.
Eur. J. Intern. Med.
PUBLISHED: 06-01-2011
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Although the association between multimorbidity and polypharmacy has been clearly documented, no study has analyzed whether or not specific combinations of diseases influence the prescription of polypharmacy in older persons. We assessed which clusters of diseases are associated with polypharmacy in acute-care elderly in-patients.
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Aging with multimorbidity: a systematic review of the literature.
Ageing Res. Rev.
PUBLISHED: 01-30-2011
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A literature search was carried out to summarize the existing scientific evidence concerning occurrence, causes, and consequences of multimorbidity (the coexistence of multiple chronic diseases) in the elderly as well as models and quality of care of persons with multimorbidity. According to pre-established inclusion criteria, and using different search strategies, 41 articles were included (four of these were methodological papers only). Prevalence of multimorbidity in older persons ranges from 55 to 98%. In cross-sectional studies, older age, female gender, and low socioeconomic status are factors associated with multimorbidity, confirmed by longitudinal studies as well. Major consequences of multimorbidity are disability and functional decline, poor quality of life, and high health care costs. Controversial results were found on multimorbidity and mortality risk. Methodological issues in evaluating multimorbidity are discussed as well as future research needs, especially concerning etiological factors, combinations and clustering of chronic diseases, and care models for persons affected by multiple disorders. New insights in this field can lead to the identification of preventive strategies and better treatment of multimorbid patients.
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Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study.
Eur. J. Clin. Pharmacol.
PUBLISHED: 01-11-2011
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We evaluated the prevalence and factors associated with polypharmacy and investigated the role of polypharmacy as a predictor of length of hospital stay and in-hospital mortality.
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Atrial fibrillation, stroke and dementia in the very old: a population-based study.
Neurobiol. Aging
PUBLISHED: 04-11-2009
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We explored the association of chronic AF with stroke, dementia and Alzheimers disease (AD) among community-dwelling elderly people. The study population consisted of 685 individuals from Stockholm (The Kungsholmen Project) who were aged 78 years and were free of dementia and clinical stroke. During the 6-year follow-up, 170 subjects developed dementia, and 86 persons experienced first-ever stroke. The incidence rate (per 1000 person-years) of dementia, AD and first-ever stroke was 72.3, 52.2, and 52.2 in persons with AF and 63.8, 54.6 and 30.6 in those without AF, respectively. AF was associated with the hazard ratio of 1.8 (95%CI, 1.0-3.4) for first-ever stroke, but not significantly associated with dementia or AD.
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Patterns of chronic multimorbidity in the elderly population.
J Am Geriatr Soc
PUBLISHED: 02-12-2009
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To describe patterns of comorbidity and multimorbidity in elderly people.
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Patterns of comorbidity and multimorbidity in the oldest old: the Octabaix study.
Eur. J. Intern. Med.
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Multimorbidity is associated with higher mortality, increased disability, a decline in functional status and a lower quality of life. The objective of the study is to explore patterns of multimorbidity in an elderly population.
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Risk factors for hospital readmission of elderly patients.
Eur. J. Intern. Med.
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The aim of this study was to identify which factors were associated with a risk of hospital readmission within 3 months after discharge of a sample of elderly patients admitted to internal medicine and geriatric wards.
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Association between human parainfluenza virus type 1 and smoking history in patients with an abdominal aortic aneurysm.
J. Med. Virol.
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Several studies have suggested that infectious agents may induce the development of abdominal aortic aneurysms and/or accelerate their progression. The aim of this study was to evaluate the presence of the respiratory-transmitted viruses such as influenza A and B and parainfluenza type 1 genomes in bioptic fragments of abdominal aortic aneurysms. Furthermore, the association between viral infection and traditional risk factors for aneurysms was investigated employing multivariate logistic regression models. The genome of parainfluenza 1 was detected in 11 out of 57 patients with abdominal aortic aneurysm, influenza A only in one, whereas none of the specimens analyzed resulted positive for influenza B. After adjustment of age, gender, and clinical diagnosis, being current smokers was associated independently with parainfluenza 1 detection in aneurysms. The identification of parainfluenza 1 in aortic aneurysm biopsies supports previous observations of a possible role of viruses in the lesion development. Smoking, by interfering with the respiratory tracts ability to defend itself and predisposing to upper and lower respiratory tract infections may accelerate the onset and progression of abdominal aortic aneurysms.
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Adverse clinical events and mortality during hospitalization and 3 months after discharge in cognitively impaired elderly patients.
J. Gerontol. A Biol. Sci. Med. Sci.
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Controversial findings are reported on hospital outcome in cognitively impaired patients. The aim of this study was to explore mortality risk according to cognitive status during hospitalization and after 3 months in elderly patients.
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Changes in trend of antipsychotics prescription in patients treated with cholinesterase inhibitors after warnings from Italian Medicines Agency. Results from the EPIFARM-Elderly Project.
Eur Neuropsychopharmacol
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The objective of the study was to assess the trend of antipsychotic prescription in elderly patients taking cholinesterase inhibitors (ChEIs) from 2002 to 2008 and the changes subsequent to two main official warnings issued by the Italian Medicines Agency to restrict their use. Elderly patients aged 65-94years who received at least one prescription of ChEIs between 1 January 2002 and 31 December 2008 were selected. We used data on prescriptions from the Lombardy Region Drug Administrative Database (Italy). The first prescription of one ChEI was used as the index day to calculate the prescription of an antipsychotic. The prescription of atypical antipsychotics in patients exposed to ChEIs declined from 21.0% in 2002 to 14.6% in 2008 (OR 0.92; 95%CI:0.90, 0.94; p<0.001), while the prescribing prevalence of typicals slightly increased (OR 1.08; 95%CI:1.03, 1.13; p=0.001). In relation to the two warnings, the prevalence of patients who received a prescription of antipsychotics was significantly lower in 2005 than 2004 (23.1% vs. 28.0%; OR 0.79; 95%CI:0.73-0.86; p<0.001) and in 2007 than 2006 (19.4% vs. 23.0%; OR 0.79; 95%CI:0.73-0.86; p<0.001). After the first safety warning the prevalence of prescriptions for risperidone and olanzapine dropped significantly, and there was a significant increase for quetiapine. Haloperidol prescriptions increased, especially after the second warning. Despite regulatory warnings issued to discourage the use of antipsychotics, they are still frequently prescribed to patients taking ChEIs. Awaiting further studies to clarify their therapeutic role, physicians should prescribe antipsychotics very cautiously and only after careful risk-benefit assessment.
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JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.